PB2582: WHY INFECTIOUS COMPLICATIONS ARE STILL THE MAIN CAUSE OF MORTALITY DURING THE TREATMENT OF PATIENTS WITH ACUTE LEUKEMIA?
Authors: Ana Vidovic, Jovan Rajic, Violeta Milosevic, Nikola Pantic, Zlatko Pravdic, Nada Suvajdzic Vukovic, Mirjana Mitrovic, Marijana Virijevic, Nikica Sabljic, Ljubica Lazic, Milenko Paunovic, Vedrana Pavlovic, Snezana Jovanovic
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Intensive chemotherapy/radiotherapy in patients with acute leukemias causes cellular injury and suppression of inflammatory responses, which increase the risk of neutropenia and febrile episodes. FN remains a common complication in chemotherapy causing serious clinical results, including death. Wide application of broad-spectrum antibiotics has effectively decreased the mortality of FN patients. Neutropenic patients who remain febrile despite 4-7 days of broad spectrum antibacterial therapy are at a high risk of invasive fungal infection. Empirical antifungal therapy with liposomal Amphotericin B or Caspofungin in high risk patients has shown to reduce the risk of invasive fungal infection by 50-80% and the risk of fungal infection related mortality by 23¬ 45%. Aims: The aim of study was to analyze frequency, causes, treatment and outcome of infectious complications in patients with acute leukemia. Methods: Sixty patients (pts) with acute leukemia treated between January 1, 2021 and March 2022 at the Clinic of Hematology, University Clinical Center of Serbia were examined. Median age was 60yrs (range 21-76yrs, F/M: 35/25pts). The diagnosis of acute leukemia was made based on WHO 2016 criteria and ELN 2022 recommendations. The principles of diagnosis and treatment of infectious complications according to ESMO 2016, NCCN 2019, ECIL-6, 2017 were applied. Patients are treated with the use of broad-spectrum antibiotics according to the de-escalation principle, and if a diagnosis of possible/probable IA is made, with the use of Voriconazole or the lipid formulation of Amphotericin. Statistical analysis was performed using the IBM SPSS 21 (Chicago, IL, USA, 2012) package. Results: AML was diagnosed in 48pts, APL in 4pts; ALL 6pts, MPAL 2 patients. 17/60 patients had a favorable cytogenetic/molecular form of the disease; 26/60pts intermediate and 17/60ptsadvers e risk group. In relation to the treatment phase: 33/60pts received induction therapy; 28/60pts consolidation; reinduction in 7/60pts; salvage protocol in 10/60pts, while 10/60pts were treated only with supportive therapy. Febrile neutropenia occurred in 50/60pts (83.3%); with a median duration of aplasia of 12 days (5-27). Blood cultures were positive in 19% of analyzed samples (183/963). The most common isolates were: Klebsiella 46.4%; E Coli 8.7%; Enterococcus 8.7%; Pseudomonads aeruginosa 9.8%; Coagulase-negative Staphylococcus 15.8%; Acinetobacet 0.5%; Staphylococcus aureus 0.5%, remaining 9.3%. In relation to the diagnosis of IA, non-culture techniques showed positive beta2 glucan in 13/60pts, and elevated values of antiAspergillus IgM and antiAspergillus IgG antibodies in 33/60pts. Chest HRCT showed the following results; normal findings in 35/60pts, GGO in 11/60pts; nodular changes in 11/60pts and consolidation in 3/60pts. 15/60pts had possible IA, and 10/6 - probable IA. Outcome: at the time of examination, 32/60pts were alive (53.3%). Median survival was 206 days (range 5-1801 days). Summary/Conclusion: Bearing in mind that serious infections in patients with hematological malignancies are the main cause of morbidity and mortality, it is necessary to further develop a strategy for the prevention and treatment of febrile neutropenia. Prompt application of empiric/preeptive antibiotic and antifungal therapy is crucial for the outcome of the treatment of these high-risk hematological patients. The teamwork of hematologists, microbiologists, infectious disease specialists, epidemiologists, and radiologists is extremely important. Keywords: Acute leukemia